Nick Buoniconti and Chronic Traumatic Encephalopathy


Nick Buoniconti was a five-time All-Pro and winner of two Super Bowls in his 14-year career in the National and American Football Leagues, an All-American at the University of Notre Dame, and a highly intelligent lawyer, player’s agent, TV sports broadcaster, and corporate executive.  He died on July 30, 2019, at age 78, of Chronic Traumatic Encephalopathy (CTE), dementia caused by multiple hits on his head.   
When  Buoniconti was 45, his son, Marc, became paralyzed from the neck down when he suffered permanent damage to his spinal cord while playing linebacker in a football game for The Citadel in Charleston, SC.  Buoniconti helped to create the Miami Project to Cure Paralysis,  and raised nearly $500 million for spinal cord and brain injury research there.  After he was diagnosed with dementia, he agreed to donate his brain to Boston University, where researchers have reported finding signs of CTE in the autopsied brains of 110 of 111 former NFL players (JAMA, July 27, 2017;318(4):360-370).
Early Years and Football Career
Nicholas Anthony Buoniconti, Jr., was born in 1940 in Springfield, MA, to parents who ran an Italian bakery.  He was the best athlete in his high school, and one of the smartest and toughest kids there. He went on to Notre Dame where he was captain of the 1961 football team and an All-American linebacker, in spite of being only 5' 11" and 210 pounds.  He was not drafted by the NFL because the scouts felt that he was too small, but he was drafted by the Boston Patriots of the upstart American Football League, in the thirteenth round of the 1962 AFL draft.  He was a four-time All-Pro in seven seasons. 
At the same time, he received a law degree from Suffolk University School of Law in Boston.  In 1969, at age 29, he was traded to the Miami Dolphins.  He led them to a 17-0 season in 1972, with a 14-7 victory over the Washington Redskins in Super Bowl VII in January 1973. No other NFL team has ever gone undefeated for an entire season.  In 1976, at age 36, he retired from football and told Sports Illustrated that he "was never seriously hurt in football . . . in spite of 520,000 hits."   
After retiring from football, he became a player's agent and a television broadcaster.  He was appointed president of the United States Tobacco Company, where he criticized studies that showed that smokeless tobacco caused cancer of the mouth. 

Progression into Dementia
Despite saying he had taken 520,000 hits but had never suffered serious injury, Buoniconti reported that he was knocked unconscious and diagnosed as having had a concussion at least ten times. He said, "Super Bowl VI against the Dallas Cowboys, I was knocked silly, and I really don’t remember much about the game."  
At age 72, he started to lose his memory and to fall when he was walking.  At age 74, he was diagnosed as suffering from dementia and agreed to donate his brain to researchers at Boston University.  He was treated at UCLA, but his memory problems only got worse.  At age 76, he was unable to play golf or read the newspaper.  He fell so many times that he was unable to walk and needed 24-hour-a-day help.  He eventually became bedridden, and died at age 78. The most likely cause of death in people suffering severe dementia is heart failure, because each day you spend in bed, your heart weakens until it becomes so weak that it cannot pump enough blood to your brain and you stop breathing.
Chronic Traumatic Encephalopathy (CTE)
CTE is progressive brain damage from repeated hits on the head, characterized by loss of short-term memory, inability to concentrate, situational confusion, depression, and changes in behavior, personality, speech, and walking, which can lead to dementia.
• Playing just one season of football can damage your brain, even if you have never been reported to have had a concussion (Science Advances, August 7, 2019).  A concussion means that you passed out or had mental changes after being hit on the head.
• CTE is not the only cause of severe loss of memory.   Before making that diagnosis, doctors will look for other causes such as Alzheimer's disease, frontotemporal dementia, vascular dementia, dementia with Lewy bodies, Parkinson disease, headaches that impair brain functions, and sleep disorders. A definite diagnosis of CTE can be made only on autopsy of the brain.
• CTE before the age of 40 often starts as anti-social behavior and mood disturbances, and in older age as loss of memory and body functions (Neurology, 2013;81(13):1122-1129). 
A very common cause of death in CTE is suicide (JAMA, July 27, 2017;318(4):360-370). Behavioral and mood symptoms include: impulsivity, depressive symptoms, apathy, anxiety hopelessness, explosivity and being verbally and/or physically violent.  As patients age, they are likely to experience:
• loss of memory
• inability to speak clearly
• visual problems severe enough to interfere with the ability to see where an object is
• inability to walk, use arms or legs, and sometimes to even to get out of bed

His Legacy
In 1992, the Buoniconti family established The Buoniconti Fund to Cure Paralysis, a non-profit organization devoted to assisting The Miami Project, which has become one of the world's leading neurological research centers.
In 2018, Buoniconti announced his support for a parents' program called Flag Football Under 14, which advises no tackle football under that age.  
Before encouraging children to go out for football (or other sports with high risk for head injuries), parents and grandparents should consider that a single hit on the head can cause loss of memory (Brain, August, 2018), and each additional head injury increases risk for brain damage. 
December 15, 1940 – July 30, 2019